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1. Pragmatic strategies to address health disparities along the continuum of care in chronic liver disease.

Author

Goldberg, David, Mathur, Amit, Wilder, Julius, Vittorio, Jennifer, Yeoman, Andrew, Rich, Nicole, Lazo, Mariana, Kardashian, Ani, Asrani, Sumeet, Spann, Ashley, Ufere, Nneka, Verma, Manisha, Verna, Elizabeth, Simpson, Dinee, Schold, Jesse, Rosenblatt, Russell, McElroy, Lisa, Wadwhani, Sharad, Lee, Tzu-Hao, Strauss, Alexandra, Chung, Raymond, Aiza, Ignacio, Carr, Rotonya, Yang, Jin, Brady, Carla, Fortune, Brett, Brahmania, Mayur, Rogal, Shari, Serper, Marina, and Patel, Arpan

Subjects
Humans, Healthcare Disparities, Continuity of Patient Care, Liver Diseases, Chronic Disease, Liver Transplantation, Health Equity, Health Services Accessibility, Liver Cirrhosis
Abstract

Racial, ethnic, and socioeconomic disparities exist in the prevalence and natural history of chronic liver disease, access to care, and clinical outcomes. Solutions to improve health equity range widely, from digital health tools to policy changes. The current review outlines the disparities along the chronic liver disease health care continuum from screening and diagnosis to the management of cirrhosis and considerations of pre-liver and post-liver transplantation. Using a health equity research and implementation science framework, we offer pragmatic strategies to address barriers to implementing high-quality equitable care for patients with chronic liver disease.

Published
2024

5. Association Between Kidney Dysfunction Types and Mortality Among Hospitalized Patients with Cirrhosis

Author

Cullaro, Giuseppe, Rubin, Jessica B, Fortune, Brett E, Crawford, Carl V, Verna, Elizabeth C, Hsu, Chi-yuan, Liu, Kathleen D, Brown, Robert S, Lai, Jennifer C, and Rosenblatt, Russell

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Kidney Disease, Renal and urogenital, Good Health and Well Being, Acute Kidney Injury, Hospital Mortality, Humans, Kidney, Liver Cirrhosis, Renal Insufficiency, Chronic, Risk Factors, Acute kidney injury, Chronic kidney disease, Cirrhosis, Hospitalizations, Mortality, National inpatient sample, Gastroenterology & Hepatology, Clinical sciences
Abstract

Background and aimsKidney dysfunction is associated with increased mortality among patients with cirrhosis. We investigated whether kidney dysfunction types [e.g., acute kidney injury (AKI), chronic kidney disease (CKD), and AKI on CKD] were differentially associated with inpatient mortality.MethodsWe utilized the nationwide inpatient sample, a nationally representative database, from 2007 to 2014. We included all hospitalizations with previously validated codes for cirrhosis or associated decompensated cirrhosis diagnoses. We defined kidney dysfunction types also from previously validated codes, and we grouped hospitalizations into the following diagnoses: normal, AKI, CKD, and AKI on CKD. Our primary outcome was inpatient mortality.ResultsThere were 1,293,779 hospitalizations with cirrhosis sampled in this study. Of these hospitalizations, 849,193 (66%) had normal kidney function, 176,418 (14%) had AKI, 157,600 (12%) had CKD, and 110,568 (9%) had AKI on CKD. We found that the proportion of hospitalizations with AKI, CKD, and AKI on CKD increased significantly throughout the study period (p

Published
2022

11. Predictors of Acute Kidney Injury Resolution and Associated Clinical Outcomes Among Hospitalized Patients with Cirrhosis.

Author

Abboud, Yazan, Rajan, Anjana, Rosenblatt, Russell E., Tow, Clara, Jesudian, Arun, Fortune, Brett E., and Hajifathalian, Kaveh

Subjects
NOSOLOGY, ACUTE kidney failure, HEPATITIS C virus, VIRAL hepatitis, PORTAL hypertension, HEPATORENAL syndrome
Abstract

Background: Acute kidney injury (AKI) is one of the common complications of liver cirrhosis. It occurs in nearly 20% of patients with cirrhosis who are hospitalized. Prior literature demonstrated that the AKI occurrence in patients with cirrhosis is independently associated with higher mortality. However, there are data assessing predictors and outcomes of AKI resolution in hospitalized patients with cirrhosis. Therefore, the aim of the current study was to identify clinical predictors of AKI resolution among inpatients with cirrhosis that are easily obtained and to evaluate the clinical outcomes of those patients. Methods: The current study is a retrospective cohort of patients with cirrhosis who were hospitalized and had AKI between 2012 and 2020 at a tertiary referral center. Patients included in this study were identified using the International Classification of Diseases 9 codes and then they were manually verified by two independent chart reviewers. AKI was classified according to the AKI Network (AKIN) serum creatinine (Cr) criteria, with AKIN resolution defined as AKIN stage 1 or lower at the time of discharge, while unresolved AKIN was defined as AKIN stage 2 or 3 at the time of discharge. For univariate analysis, Fisher's exact and the two-sample T-test were utilized. For multivariable analysis, stepwise logistic regression was performed to evaluate variables associated with AKIN resolution. Survival curves were estimated and compared using the Kaplan–Meier method and Log-Rank Test. A p-value cutoff of 0.05 was used for statistical significance. Results: Between 2012 and 2020, there were 140 patients who were included (59% males). The majority of patients had viral hepatitis (54%) as the cirrhosis etiology with 80% of them having hepatitis C virus. Most patients had fluid-responsive AKI (49%), and stage 1 AKIN (69%). In terms of outcomes, the majority of patients (117 patients; 84%) had AKIN resolution at the time of discharge. In the multivariable analysis, after adjusting for clinical meaningful variables, our study shows that higher albumin value at the time of admission (adjusted Odds Ratio "aOR" = 3.28; p = 0.01) and non-metabolic dysfunction-associated steatotic liver disease (non-MASLD) cirrhosis (aOR = 9.43; p < 0.01) were variables associated with higher odds of AKIN resolution at the time of discharge. Conversely, we show that a higher Cr value at the time of admission was associated with lower odds of AKIN resolution at the time of discharge (aOR = 0.31; p < 0.01). When evaluating mortality, patients with unresolved AKIN at the time of discharge had higher rates of in-hospital mortality (p < 0.01) compared to those with resolved AKIN. Survival curve analyses using the Kaplan–Meier method indicated that patients with resolved AKIN experienced higher 90-day survival rates (p < 0.01). Additionally, those with resolved AKIN demonstrated greater transplant-free survival compared to patients with unresolved AKIN at both the 1-year (p = 0.04) and 3-year (p < 0.01) follow-ups. Conclusions: When evaluating clinical predictors of AKIN resolution in admitted patients with cirrhosis, our study showed that a higher admission albumin value and non-MASLD etiology of cirrhosis were associated with higher odds of AKIN resolution at the time of discharge. Conversely, a higher admission Cr value was associated with lower odds of AKIN resolution at the time of discharge. We also demonstrate that AKIN resolution during index admission was associated with improved short- and long-term transplant-free survival (up to 3 years). Our findings warrant external validation in larger cohorts to further evaluate the impact of inpatient AKI resolution on cirrhosis outcomes. Our findings can help clinicians predict AKIN outcomes and encourage more aggressive management of AKI, especially in high-risk patients, which can improve mortality. [ABSTRACT FROM AUTHOR]

Published
2024
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16. Gastrointestinal and Hepatic Manifestations of 2019 Novel Coronavirus Disease in a Large Cohort of Infected Patients From New York: Clinical Implications

Author

Kaplan, Alyson, Gonzalez, Susana, Skaf, Daniel, Ang, Bryan, Choi, Anthony, Wong, Angela, Aboubakr, Aiya, Niec, Rachel, Rohan, Elizabeth, Speiser, Julia, Ying, Xiaohan, Pan, Yushan, Ianelli, Mallory, Rajan, Anjana, Ravishankar, Arjun, Tewani, Sunena, Dawod, Enad, Dawod, Qais, Rosenblatt, Russell, Carr-Locke, David, Shah, Shawn, Mahadev, Srihari, Wan, David, Crawford, Carl, Sholle, Evan, Brown, Robert, Cohen, David, Hajifathalian, Kaveh, Krisko, Tibor, Mehta, Amit, Kumar, Sonal, Schwartz, Robert, Fortune, Brett, and Sharaiha, Reem Z.

Published
2020
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17. COVID-19 in solid organ transplant recipients: Initial report from the US epicenter

Author

Pereira, Marcus R., Mohan, Sumit, Cohen, David J., Husain, Syed A., Dube, Geoffrey K., Ratner, Lloyd E., Arcasoy, Selim, Aversa, Meghan M., Benvenuto, Luke J., Dadhania, Darshana M., Kapur, Sandip, Dove, Lorna M., Brown, Robert S., Jr., Rosenblatt, Russell E., Samstein, Benjamin, Uriel, Nir, Farr, Maryjane A., Satlin, Michael, Small, Catherine B., Walsh, Thomas J., Kodiyanplakkal, Rosy P., Miko, Benjamin A., Aaron, Justin G., Tsapepas, Demetra S., Emond, Jean C., and Verna, Elizabeth C.

Published
2020
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19. Provider Attitudes and Practice Patterns for Direct-Acting Antiviral Therapy for Patients With Hepatocellular Carcinoma

Author

Rich, Nicole E., Yang, Ju Dong, Perumalswami, Ponni V., Alkhouri, Naim, Jackson, Whitney, Parikh, Neehar D., Mehta, Neil, Salgia, Reena, Duarte-Rojo, Andres, Kulik, Laura, Rakoski, Mina, Said, Adnan, Oloruntoba, Omobonike, Ioannou, George N., Hoteit, Maarouf A., Moon, Andrew M., Rangnekar, Amol S., Eswaran, Sheila L., Zheng, Elizabeth, Jou, Janice H., Hanje, James, Pillai, Anjana, Hernaez, Ruben, Wong, Robert, Scaglione, Steven, Samant, Hrishikesh, Kapuria, Devika, Chandna, Shaun, Rosenblatt, Russell, Ajmera, Veeral, Frenette, Catherine T., Satapathy, Sanjaya K., Mantry, Parvez, Jalal, Prasun, John, Binu V., Fix, Oren K., Leise, Michael, Lindenmeyer, Christina C., Flores, Avegail, Patel, Nayan, Jiang, Z. Gordon, Latt, Nyan, Dhanasekaran, Renumathy, Odewole, Mobolaji, Kagan, Sofia, Marrero, Jorge A., and Singal, Amit G.

Published
2020
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42. Prognostic Factors in Alcohol-associated Liver Disease Patients Presenting With First Evidence of Ascites

Author

Fahoum, Khalid, primary, Shen, Nicole T., additional, Basu, Elora, additional, Lee, Jihui, additional, Kaplan, Alyson, additional, Salajegheh, Annaheta, additional, Rosenblatt, Russell, additional, Jesudian, Arun, additional, Lucero, Catherine, additional, Fortune, Brett, additional, Safford, Monika, additional, and Brown, Robert S., additional

Published
2023
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50. Hepatology Highlights

Author

Rosenblatt, Russell, Brown, Robert S., Jr., Mukewar, Saurabh, Schneider, Yecheskel, Schwartz, Robert E., Cohen‐Mekelburg, Shirley, Tow, Clara, Novikov, Aleksey, Russo, Nicholas, Tafesh, Zaid H., and Gupta, Vikas

Published
2018
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